THE CHOLERA IN HAMBURG.

By MISS ANNESLEY KENEALY.

MISS ANNESLEY KENEALY.

To some of my hearers it may seem as if the subject of my paper is rather gruesome, but upon reflection it would appear to be a matter not only of public interest, but of national welfare, that every possible ray of light should be cast on the mysteries and development of that dreaded cholera which worked so much destruction in Hamburg during the autumn of 1892, and which appeared to threaten the whole continent of Europe. An account of the rise, the progress and the decline of the epidemic in that city may be instructive and suggestive.

Cholera is a disease of which little more is known now than was known when Eugene Sue described it so graphically in the pages of "The Wandering Jew"–a description which is thrillingly realistic to anyone who has stood face to face with it. It arises silently and stealthily, doing its dreaded work surely and without pity. Atmosphere and climate conditions affect the development of the germ, for cholera is essentially a germ disease, and impure water and bad sanitation complete the growth. These conditions combined in September, 1892, in Hamburg, and adjoining cities were startled to find the disease so close upon them. As we drove through the streets of the city after a hurried journey from England to the seat of war, if one may so express it, we caught glimpses of the so-called "cholera streets" where the disease arose. The architecture in its antiquity and picturesqueness filled us with admiration; the canals of Stygian blackness, flowing on a level with the lower floors of the houses, reminded us of bits of old Venice, and wanted only the gondoliers to complete the illusion. But while one's artistic senses were satisfied, one's sanitary knowledge rose in revolt against the neglect of all the laws of health as typified in these charming "slums." It would appear that in the towns of Europe it is almost impossible for Art and Hygiene to walk hand in hand. The beautiful "White City" has shown us that they may do so in America. The condemnation of the "cholera streets" is a gain to sanitation, but a terrible sacrifice of art on the altars of the public weal.

The gloomy station at which we alighted was typical of the deserted condition of the city, five Sisters of Mercy and ourselves being the only travelers. To our minds the lapse of duty on the part of the railway employes in forgetting to take our tickets [Page 355]
was the strongest possible proof of public demoralization that we saw. That German
officialdom could be caught napping was indeed one of the wonders of the cholera
epidemic. The city and its streets looked as if under the shadow of a great destiny.
Funerals and funeral wreaths, mourners and signs of mourning met us at every corner.
The absence of women and children was very conspicuous. It was as if some Pied
Piper had passed along and robbed the city of its ornaments. But we learned that
forty thousand of the residents had fled on the first mention of cholera, a large
proportion of these being women and children.

A picturesque procession, known as the Volunteer Company of Health of Höhenfelde, met us on our route. It consisted of some two dozen men and boys with pails
and carboys of chemicals, whose self-imposed duty it was to go to the places where
the disease had been, and thoroughly disinfect and cleanse the rooms and houses. In
the early days of the epidemic undoubtedly great confusion reigned; but military discipline soon asserted itself, and out of chaos came order of a most admirable type. I
venture to think that few cities of the world would have shown such resource and
strength to meet the invasion of so formidable a foe as did Hamburg. The only weak
point about the siege was that in the beginning of the epidemic the authorities refused
to acknowledge that the enemy was within their gates. Thus the germ was able to
take possession of many strongholds which could have been rendered impregnable if
proper measures of safety had been adopted sufficiently early. When the fact that
cholera had taken possession of the city could no longer be concealed, military
cordons were drawn around the infected quarters, ingress and egress being limited to
physicians and attendants. But as the proportions of the disease increased, it was
found necessary to clear the hospitals of their ordinary patients to make room for the
cholera-stricken. In the Eppendorf Hospital, where my sister and I spent some three
weeks, there was found accommodation for nearly two thousand patients. This
hospital, which is undoubtedly one of the most beautiful in the world, and which closely resembles the Johns Hopkins Hospital of Baltimore, reminded us in its proportions and appearance of a friendly fortress strong to save, and offering a safe refuge to those taking shelter within its walls. The grounds and gardens, full of beautiful flowers and shrubs, the beautiful creepers covering the building, looked, especially at night, when lighted up by electricity, a veritable scene in fairyland. But this likeness was limited to the externals. In the wards there was only the grim realism of suffering and death. In addition to the large wards and partitions, further accommodation was furnished by hospital tents similar to those used in the Franco-Prussian war, which stood picturesquely dotted about in a large waste field adjoining the grounds. These tents grew up almost like the beanstalk of the fairy story–in a single night–and bore testimony to the excellency of the arrangements made by those in authority. Rows of beds stood ready for occupancy, electricity lighted up the interiors as well as the outside, and the tents flying the Red Cross, the emblem of charity and pity, gave one the sense of being in the midst of some military encampment. From a theoretical standpoint, treatment in the open air under canvas would seem a desirable method of treating cholera, and it would appear that thus there would be less danger of the spread of the disease; but, practically, it has been shown that in the cold collapsed condition of the patient, the open air is too depressing. An admirable system of police notification of fresh cases was established, prompt removal being effected by a service of two horsed cabs, which were kept busy night and day. Each vehicle was accompanied by an official, whose duty it was to take the name and address of the stricken patients and furnish this to the hospital, thus affording a ready means of identification in case of death. In the early days of the epidemic, patients were picked up in the streets, unconscious, dying and dead, and were carried to the various hospitals, without any means of tracing their families and friends.

The disease originated in the shipping quarter, having been brought to Hamburg
from the Black Sea by a vessel which successfully concealed the fact that its crew had
been stricken by cholera some two months previously. It was natural, therefore, that [Page 356]
the sailors and those who go down to the sea in ships should be first attacked. Many foreigners fell victims, whose names never will be known, and whose friends will vainly wait for tidings from and of the lost ones. Curiously enough, my sister was recently asked by a German woman, whom she met in an English country town, whether she could give her any news of a sister who had been lost sight of during the Hamburg epidemic, and who, it was feared, must have shared the common fate. It was by no means unusual for whole families to be taken to the same hospital and distributed in
the various wards according to sex and accommodation. Spacious and roomy as these
wards were, their capacity was tried to the utmost, the beds, of necessity, being so close
that the patients might almost have joined hands round the circumference of the ward.
Had not the ventilating and sanitary arrangements been almost perfect, a very serious
condition of things would have arisen. The stone floors admirably lent themselves to
assidious deluging and mopping with suitable disinfectants. Thus the career of the
germ was early cut off.

The appearance of the cholera patient is typical and unlike that of one suffering
from any other disease. He is collapsed, with a dusky blackness of skin in many
cases, giving the suggestion that his body has been thickly powdered with coal-dust.
The normal lines are blackened and deepened, the expression haggard and wan.
Listlessness and apathy are expressed in every attitude, and the mental condition, unless
the case be complicated with delirium, is distinctly one of lethargy. The rapid
emaciation of the body through the draining of the tissue fluids is characteristic only of
cholera, and is noticeable in all severe cases. It gives an aged, withered look to the patient, and even the dimpled, rounded limbs of the young child will lose contour, and become wrinkled and shrunk in the space of a few hours. A consuming thirst is so great as to almost absorb all other sensations, and results in the enormous consumption of liquids and in part restores the loss of the fluid components of the body through the disease. This thirst is constant and unrelievable, and was one of the difficulties of the situation. Hard pressed as we were to supply the bare needs of our patients, it was most pathetic to be frequently obliged to ignore for a space their entreaties for drink of any and every kind, and to note the wistful, thirsty eyes of the occupants as we passed their beds to supply some one whose needs were greater. The tight clutch of baby hands on mugs
and glasses told us how real was the desire for liquid. Often in the midst of our duties
we would hear a small thud on the ground, followed by patter of little feet that scarcely
knew how to walk, setting out on a small voyage of discovery and investigation into
the contents of bottles and jugs that stood in the wards. It has been said that a large
proportion of cholera patients die of fear, but I believe this conclusion to have been
reached from observations made in India. Doubtless the nervous, highly-strung
Hindoo would see in the invasion of cholera the finger of fate, against which he would
believe medical skill to be quite powerless, but the phlegmatic Teuton gave no
evidence of a belief in an unassailable Kismet. It frequently occurred to us that the
choleraic condition killed all natural emotion. Little sisters side by side in bed, one
would die, and the other would take no notice and feel no fear. Older children would
see their mothers carried dead from the wards, and would watch the procession as of
something afar off that had no relation to them. The rapid succession of patients was
most bewildering–not, unfortunately, because of recovery, but because of deaths.
Almost before we had time to know the faces of our patients they were removed to the
mortuary, and others were ready to take the vacant beds. Cholera spares neither sex
nor age. Our patients ranged from the baby at the breast to those who had fulfilled
their three-score years and ten. The fight was by no means always to the strong, and
victory not at all necessarily to those of robust nature. Treatment consisted chiefly of
venous injections of warm salt and water, combined with hot, stimulating baths and
packs, but the general consensus of medical opinion at Hamburg was that no remedy
could in any sense be relied on. Our own experience bears out that which has been
aptly said regarding the disease, that "if the patient be strong enough, or can in any
way be assisted to survive the attack, it might be said he was cured of cholera, but it [Page 357]
was the man who lived, and not that the cholera was killed." Prevention is the only cure. Epidemics are nature's health officers, and they do their work efficiently if they are sufficiently serious to impress themselves upon the public mind. Slowly and by
degrees, as malarial and deadly spots in India are drained and sanitated, the outbreaks
of cholera are fewer and less serious. Disease is a foe that recedes as the missionaries
of health advance. Gradually, as more light is thrown on the science of hygiene, the
legions of microbes ever lurking in darkness and dirt are stifled in their growth and
become weaker and weaker. The insanitation of India, the starvation and misery of
Russia, are a standing menace to the peoples of Europe, and so long as these exist,
each year we will have to gird up our strength to meet the foe, and shall have to
grapple hard to keep him to his own quarters–the quarters of dirt and uncivilization.

In these days of express speed we have many advantages. The railroad and steamboat bring us into relation with the uttermost ends of the earth and the peoples thereof, but we must not lose sight of the fact that at the same time we are brought into contact with the moral and physical diseases of all these different peoples.

The "sins of Hamburg" were great, and eventually found her out. Nature had dealt very gently with her breaches of the eternal laws of health. Thirteen comparatively mild epidemics had failed to suggest to the city authorities the necessity of putting their house in order. The Elbe water was still supplied in all its native and imported impurity, and then came the fourteenth warning, sadder, sharper and effectual, and Hamburg has risen to the occasion. From her commercial position and harbor accommodations Hamburg is peculiarly open to the importation of foreign diseases, and it is only by keeping her hearths well garnished and the city household in health that she can afford to admit suspicious visitors. It is a matter of menace and regret that she did not enforce compulsory cremation during the cholera epidemic. A beautiful crematorium, hitherto practically unused, stood all through the epidemic as a silent but eloquent monument to the prejudices of the people. In certain conditions of the soil a cholera body is more dangerous to the community when below than when above the ground, and it is much to be feared that a heavy day of reckoning must come when it is remembered that countless thousands of cholera corpses are giving their noxious emanations to the atmosphere of Hamburg.

A physician, recently writing in a professional paper, makes use of the following
astonishing statement that cholera gives a new lease of life to the sufferer. This may be so if he means us to understand some transcendental lease in another sphere, but if he alludes to a lease here below, I cannot but think that the most of us should object to the terms of the agreement. There is no question but that, in the marvelous cleaning up of Europe that has followed the cholera scare, there will be found new leases of life to whole nations consequent to improved health conditions. Let me commend the system to Chicago. In my stay here during the World's Fair I have noted whole rows of "cholera streets," which have not even the excuse of being artistic.

Tracts were distributed broadcast among the patients in the German hospitals persuading them in solemn language that the cholera epidemic was a merciful dispensation on the part of a wise Providence, and that the gentle chastisement had been sent as a reminder that their ways of life were evil. But not a word was said of the evil ways of the authorities of the city, who allowed the water supply to become so polluted that "death in the cup" might be taken more as a statement of fact than as a poetical exaggeration.

In conclusion let me offer a deserved tribute to the energy, the self-denial and devotion of Hamburg and her sons and daughters during the period of suffering. Nurses, physicians and attendants worked with a singleness of purpose and forgetfulness of self. Much illness arose and many deaths occurred in the ranks, but all stood by their guns with a courage that was one of the most hopeful beacons at a time when encouraging signals were much needed.

Truly "unhappy Hamburg" has been the scapegoat for sanitary sins. She was [Page 358]
far in advance of most continental cities in sanitation, notwithstanding she was singled out and other much worse offenders were passed by unharmed. But the warning has been to all to gird up their loins and prepare their strongholds to meet attacks from an enemy so mighty and subtle and mysterious that his coming is always stealthy, and, as it were, in the dead of night.

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Miss Annesley Kenealy is a native of Sussex, England. Her parents were the late Edward Kenealy, Q.C., LL.D., and M.P., and Elizabeth Kenealy. She was educated by private tutors in Latin, Greek, science, mathematics, etc., and studied at the London College of Medicine for women. She has traveled, studying the hospital systems in the United States, Norway, Holland, Belgium, France, Germany, Italy, Spain and Portugal. Her special work has been in the interest of the social and political advancement of women, also in the interests of philanthropy. She was a volunteer nurse during the cholera epidemic in Hamburg in 1892. She was appointed by the Royal Commission of England a judge in the Hygienic and Sanitary Section of the World's Fair, Chicago, 1893, and was invited to prepare the official report of the Department for presentation to U.S. Congress. Her principle literary works are contributions to the "British Medical Journal," many leading English periodicals, pamphlets, and books. Her profession is that of a lecturer on health to national health societies and the British County Councils. Her postoffice address is Watford, Herts, England.

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